Kapala A, Szmytkowski J, Stankiewicz W, Dabrowiecki S
Department of General and Endocrine Surgery, Nicolaus Copernicus University Hospital, Bydgoszcz, Poland.
Eur J Vasc Endovasc Surg. 2006 Sep;32(3):316-7. doi: 10.1016/j.ejvs.2006.03.011. Epub 2006 May 22.
The radiocephalic wrist fistula remains the "gold standard" for primary vascular access placement according to NKF -DOQI guidelines. However, liberal inclusion criteria for dialysis therapy, as well as increasing longevity and prevalence of diabetes, have led to an increased number of patients with distal vessels unsuitable for vascular access creation. Another available location, and one used with increasing frequency, is the anterior cubital fossa. Arteriovenous anastomoses in this location leads to the development of two possible vascular accesses: cephalic and basilic. The basilic vein needs to be transposed to the anterior aspect of the arm. However, this procedure is technically difficult and carries a high risk of complications, often associated with axial torsion or kinking of the transposed vein during placement in the subcutaneous tunnel. The authors propose a simple technical modification which minimizes the risk of these complications. The main advantage is the prevention of axial torsion and kinking, as well as avoiding venous stenosis by transecting the vein at its widest point.
根据NKF - DOQI指南，桡动脉-头静脉腕部内瘘仍是初次血管通路建立的“金标准”。然而，透析治疗宽松的纳入标准，以及糖尿病患者寿命延长和患病率增加，导致不适于建立血管通路的远端血管患者数量增多。另一个可用部位，且使用频率日益增加的部位是肘前窝。在此部位进行动静脉吻合可形成两种可能的血管通路：头静脉和贵要静脉。贵要静脉需要转位至手臂前方。然而，该操作技术难度大，且并发症风险高，并发症常与转位静脉在皮下隧道置入过程中的轴向扭转或扭结有关。作者提出了一种简单的技术改良方法，可将这些并发症的风险降至最低。主要优点是防止轴向扭转和扭结，以及通过在静脉最宽处横断静脉来避免静脉狭窄。
